Longnecker's Anesthesiology > Part 3. Safety and Risk Reduction in Anesthesia Practice > Chapter 25. Approaches to Quality Improvement in Anesthesia Care David S. Smith, MD, PhD, and Lee A. Fleisher, MD

Acute Pain Management

"Quality and safety standards with respect to acute pain appear to be the least developed. Part of this relates to the fragmentation of acute pain care between surgeons, nurses, and anesthesiologists that occurs in many institutions. It is also related to philosophical differences among the participants toward the treatment of acute pain and the lack of a quantitative measure outside of patient observation. Practice guidelines from the American Society of Anesthesiologists emphasize that a single approach to pain management may not be appropriate for all types of patients and that multimodality approaches tailored to the patient's clinical conditions and therapeutic requirements have the greatest probability of producing adequate pain relief with the least risk of undesirable side effects.⁴⁶ The JCAHO has published specific pain-management standards that may help to increase the resources devoted to this often-ignored aspect of patient care.⁴⁷ The basic underpinning for determining the efficacy and safety of pain control efforts is the requirement that patient pain needs to have appropriate assessment and management. There are two problems, however, as regards this underpinning. First, many institutions have not yet implemented appropriate pain assessment and control programs. The American Pain Society guidelines were formulated in 1995 and provide a very precise approach to instituting an effective approach to acute pain care.⁴⁸ Second, and the focus of this section, is once an acute pain care plan is in place, how does..."